Description of activity:
'Support from the Start' is about ensuring that mainstream services are doing all that can be done to improve the health and well being of children and families in the early years of life in areas of East Lothian where there is a record of health disadvantage.
The project focuses on the communities of Prestonpans, Musselburgh East and Tranent, which have significantly poorer health outcomes than is average for East Lothian.
Since Support from the Start was launched in March 2009, a wide range of activity has taken place that have been initiated or influenced by the Equally Well test site.Â Much of this activity, although not all, has been directed or influenced by individuals that were nominated as service or community champions, who support the engagement of communities in the Support from the Start project.
However, activity was not the key objective of Support from the Start, rather the test site's primary purpose is to generate learning about how services and communities can better respond to the challenge of inequality in health. So what has been learned so far about the areas we said were the criteria for success?
The following is a flavour of the kind of learning that is taking place:
Children and families are engaged with the key health improvement challenges
We have learned that when you ask communities what they see as the health issues facing them and their children they respond.
In Wallyford, when asked during a civic conversation event, parents identified a range of issues including oral health. Local services responded to this by looking at what the oral health of pre-school children was like and found it to be very poor compared to the East Lothian average. When we mapped what was contributing to improving oral health by P1 it was evident that Wallyford was in fact receiving less of a service than areas with better oral health. Services worked together to redesign oral health provision and now the level of service has improved and its impact will be evaluated over the next three years. Perhaps most importantly the new provision has been developed as a partnership of local services that has involved parents through key community institutions such as schools and community centers.
Parents can access support for healthy living when they need it
We have learned that in order for mainstream services to respond to the healthy living needs of parents and early years children they need to have the capacity to:
- communicate with service users and partners about health,
- be flexible in their response to need,
- constantly innovate.
The health visiting team in Tranent were aware through their practice that a group of women in the community were not engaging with some of the services established to support mothers of small children / pregnant women. These women were often older first time mothers who felt their needs to be different from mothers of a younger age group. They have developed a support group for isolated / vulnerable first time older mother called 'Mums in the Middle' in an attempt to provide healthy living support to these mothers at a time when they need it.
The 'Active Schools' team recognizing a need for parents and children to be able to access outdoor play and 'adventure' in extra curricular settings that was not being met in current provision. They researched, developed and piloted an extra-curricular outdoor play resource that could be utilised by trained volunteers. After a successful pilot they are rolling out this resource to school and nurseries and training for volunteers as part of Active schools community training programme
Parents and children have good quality child friendly environments
We have learnt that service provision is not always matched to needs and may not be provided in a way that is acceptable to families. Sometimes it takes both service providers and communities to think differently about a problem.
The 'civic conversation' in Whitecraig identified that play opportunities, was one of the major issues that community members felt could be improved to impact on health and well being. The community focus was on the lack of physical play amenities.
A partnership approach working with the community has helped to create a play based service that is acceptable and used by the community. The type of play provision was not the focus of the initial conversation with the community, but the community seem to have got behind what services have been able to do in response to the conversation.
Those most at risk of poor health receive the most support
It is known that inequality can be deepened as an unintentional consequence of the way services are organised. We have learnt that mapping the pathways to service outcomes is one way of identifying where inequality may be generated by service provision.
Regrettably in some areas of East Lothian the statistics for smoking in pregnancy remain high. When we mapped what services are currently doing to reduce smoking in pregnancy it became apparent that there is very little in the way of pro-active support, and very little early intervention. If you have made a decision to stop smoking and have the confidence to ask for help services will provide it. A similar pattern emerges for breast feeding - if you have made a choice to breast feed and have the confidence and knowledge needed to ask for help, then you will get it. This pattern of service tends to favour people who are well informed and confident about accessing services and hence may be disproportionately provided to well educated and affluent people. Services for smoking and breast feeding are being developed to have a greater emphasis on pro-active support and early intervention.
Community engagement is an important aspect of Support from the Start. A â€˜civic conversation' process has been developed to engage communities and service providers â€“ the civic conversation shapes a dialogue process for tackling health inequalities in the early years.